deamino-arginine-vasopressin and Escherichia-coli-Infections

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antidiuretic Agents; Cefotaxime; Deamino Arginine Vasopressin; Diabetes Insipidus; Escherichia coli Infections; Female; Gentamicins; Humans; Hydrocephalus; Infant, Newborn; Infant, Premature; Injections, Intravenous; Magnetic Resonance Imaging; Meningitis, Escherichia coli; Ventriculostomy

Gastroenteritis due to Escherichia coli O157:H7 occurs in young children and is associated with consumption of under cooked beef. Approximately 5-10% of patients will develop hemolytic uremic syndrome (HUS): renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. A 6-year-old boy was admitted with abdominal pain, guaiac positive stool, decreased urine output and elevated creatinine levels. Hemodialysis was initiated upon rapid progression to anuria. On hospital day # 5 he developed acute abdominal pain, which was different from his initial assessment. Exam revealed focal tenderness in the right lower quadrant with localized guarding and rebound. Ultrasound demonstrated a dilated, fluid filled tubular structure in the RLQ concerning for appendicitis. Based on these findings the patient was taken to the operating room for a laparoscopic appendectomy. The patient had undergone dialysis the previous day and was preoperatively treated with DDAVP to minimize the risk of bleeding. The procedure occurred without complication and final pathology confirmed acute appendicitis. This case highlights the unique clinical scenario in which patients with HUS require operative intervention. Surgical procedures can be performed on these patients, however, all precautions should be taken to minimize the risk of bleeding, including the use of preoperative DDAVP.

Topics: Acute Disease; Appendicitis; Child; Deamino Arginine Vasopressin; Escherichia coli Infections; Escherichia coli O157; Hemolytic-Uremic Syndrome; Hemostatics; Humans; Male; Shiga Toxins; Treatment Outcome

Although disorders of ADH secretion associated with meningitis are usually consistent with the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), central diabetes insipidus (DI) is an exceptional complication of meningitis. Transient DI as a complication of Escherichia coli (E. coli) meningitis due to ventriculoperitoneal shunt in an 18-month-old boy is presented. Blood and spinal fluid cultures yielded E. coli, sensitive to cefotaxime. The DI arose on the day 3 after admission and continued to the day 20. Treatment comprised cefotaxime, dexamethasone, fluid adjustment and vasopressin. The course of our case supports that in cases of bacterial meningitis, initial fluid restriction may occasionally result in dangerous conditions. Therefore, all children with bacterial meningitis should be followed closely not only in terms of SIADH but also DI. To our knowledge this is the first transient DI associated with E. coli-caused meningitis case reported.

Topics: Dandy-Walker Syndrome; Deamino Arginine Vasopressin; Diabetes Insipidus; Escherichia coli Infections; Humans; Infant; Male; Meningitis, Bacterial; Polyuria; Radioimmunoassay; Renal Agents; Tomography, X-Ray Computed; Vasopressins; Ventriculoperitoneal Shunt

The authors studied the effect of indomethacin and naproxen on the changes of renal prostaglandin E and F2 alpha concentration in experimental kidney infection, as well as the action of arginine-vasopressin in healthy rats. Naproxen proved to be an effective inhibitor of prostaglandin synthesis, as did indomethacin. In control animals an increased prostaglandin E and F2 alpha synthesis was observed caused by arginine vasopressin. It is supposed that ADH--depending on its concentration--has a metabolic modulator role in prostaglandin synthesis, which raises the possibility of a self-regulatory mechanism of water reabsorption.

Topics: Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Dinoprost; Escherichia coli Infections; Female; Indomethacin; Kidney; Naproxen; Nephritis; Prostaglandins E; Prostaglandins F; Rats; Rats, Inbred Strains